Lipson D J, Naierman N
Alpha Center, Washington, DC, USA.
Health Aff (Millwood). 1996 Summer;15(2):33-48. doi: 10.1377/hlthaff.15.2.33.
Growing competition in health care markets and Medicaid managed care, combined with cuts in government funds that subsidize care to the uninsured, are challenging the viability of the safety net. In response to these pressures, "safety-net" providers in fifteen communities are integrating vertically and horizontally, contracting with or forming managed care plans, and seeking to attract paying patients. Such strategies appear to be successful for community-based primary care clinics, but other providers--including hospitals that cannot quickly develop primary care capacity, most local health departments, and providers that fail to attract Medicaid patients--are more vulnerable to health system changes. While the safety net may be intact now, access to care among the uninsured is more at risk in communities without state programs or local taxes that subsidize such care.
医疗保健市场和医疗补助管理式医疗领域竞争日益激烈，再加上政府用于补贴为未参保者提供医疗服务的资金削减，安全网的可持续性正面临挑战。为应对这些压力，15个社区的“安全网”提供者正在进行纵向和横向整合，与管理式医疗计划签约或组建此类计划，并试图吸引付费患者。这些策略对社区基层医疗诊所似乎很成功，但其他提供者——包括无法迅速发展基层医疗服务能力的医院、大多数地方卫生部门以及未能吸引到医疗补助患者的提供者——更容易受到卫生系统变革的影响。虽然目前安全网可能还算完整，但在没有州计划或地方税收补贴此类医疗服务的社区，未参保者获得医疗服务的风险更大。
